BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We per...BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.展开更多
BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with commu...BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.展开更多
Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely face.Diagnostic options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limitin...Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely face.Diagnostic options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limiting the use of invasive hemodynamic monitoring or imaging tests.The mortality rate due to sepsis can be assessed via multiple scoring systems,for example,mortality in emergency department sepsis(MEDS)score and sepsis patient evaluation in the emergency department(SPEED)score,both of which quantify the variation of mortality rates according to clinical findings,laboratory data,or therapeutic interventions.This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.Methods:The study is a cross-sectional,prospective study including 61 sepsis patients in ED in Suez Canal University Hospital,Egypt,from August 2017 to June 2018.Patients were selected by two steps:(1)suspected septic patients presenting with at least one of the following abnormal clinical findings:(a)body temperature higher than 38℃ or lower than 36℃,(b)heart rate higher than 90 beats/min,(c)hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg,and(d)white blood cell count higher than 12,000/μL or lower than 4000/μL;(2)confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment(SOFA)score following infection.Other inclusion criteria included adult patients with an age≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection.Patients were shortly follow-up for the 28-day mortality.Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome.The receiver operating characteristic curves were also done for MEDS and SPEED scores.Results:Among the 61 patients,41 died with the mortality rate of 67.2%.The mortality rate increased with a higher SPEED and MEDS scores.Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors(p=0.004 and p<0.001,respectively),indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients.Thereafter,the receiver operating characteristic curves were plotted,which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87(0.788-0.963)as compared with 0.75(0.634-0.876)for MEDS.Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system.For every one unit increase in SPEED score,the odds of 28-day mortality increased by 37%.Conclusion:SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients.Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.展开更多
目的 探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患...目的 探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患者预后的评估价值，并探究新的评分方法。 方法 回顾性分析2016-01～2016-08就诊于清华大学附属北京清华长庚医院急诊科的215例感染患者，记录性别、年龄、既往基础疾病、就诊时生命体征、感染部位及相关实验室检验，分别进行NEWS、MEWS和MEDS，以进入研究后28 d生存情况分为死亡组与存活组，分析两组间各评分差异。为探究新的评分方法，进一步应用Logistic回归分析评估各因素与28 d预后的关系，并最终获得拟合方程。应用受试者工作特征曲线（ROC曲线）比较各评分系统及拟合方程对28 d预后的预测能力。结果 215例急性感染患者28 d 病死率为14.88%。死亡组NEWS、MEWS和MEDS均高于存活组。单因素Logistic回归分析显示，年龄、恶性肿瘤病史、心率、呼吸频率、收缩压、血氧饱和度（SpO2）、血小板、红细胞压积、血肌酐（serum creatinine, Scr）、肾小球滤过率（estimated glomerular filtration rate, eGFR）是28 d死亡的预测因素（P＜0.05）。NEWS、MEWS、MEDS和联合多变量建立的拟合方程对28 d死亡预测的ROC曲线下面积分别为0.881、0.757、0.935和0.954。NEWS与MEDS比较差异无统计学意义（P＞0.05），与MEWS比较差异有统计学意义（P＜0.01）。联合多变量后建立的拟合方程敏感度最佳，曲线下面积最大，优于MEWS（P＜0.01）及NEWS（P＜0.05）。结论 MEDS的预测能力同NEWS能力相当，优于MEWS。联合MEDS与心率、Scr获得的拟合方程的预测能力更优于NEWS和MEWS。展开更多
目的:评估分流早期预警评分(triage early warning score,TEWS)在急诊创伤患者中预后及急诊科应急处置预测的准确性。方法:在一所教育和研究型三甲医院进行为期约4个月的前瞻性研究,符合纳入标准的创伤患者均进行TEWS,观测结局指标为28 ...目的:评估分流早期预警评分(triage early warning score,TEWS)在急诊创伤患者中预后及急诊科应急处置预测的准确性。方法:在一所教育和研究型三甲医院进行为期约4个月的前瞻性研究,符合纳入标准的创伤患者均进行TEWS,观测结局指标为28 d病死率、急诊科应急处置方式(使用心肺复苏术/电除颤和机械通气)。结果:纳入研究的对象TEWS≤9分,10~13分,≥14分的病死率分别为0.98%,52.63%和80%,TEWS每增加1分,则死亡相对危险度为2.14(95%CI:1.759~2.604)。TEWS预测患者28 d病死率时,最佳截断值>8分,敏感度为87.10%(95%CI:0.2%~96.4%),特异度为92.47%(95%CI:89.5%~94.8%),ROC曲线下面积为0.929(95%CI:0.902~0.951);对急诊科预测的患者使用心肺复苏术/电除颤应急处置时,ROC曲线下面积为0.969(95%CI:0.949~0.983);对急诊科预测的患者使用机械通气应急处置时,ROC曲线下面积为0.897(95%CI:0.865~0.923)。结论:TEWS能有效地预测急诊科创伤患者的预后及急诊科内应急处置方式的使用。展开更多
目的探讨改良早期预警评分(modified early warning score,MEWS)在早期识别潜在危重症患者中的应用价值。方法选取我院急诊科2017年1月-2019年1月收治的200例患者为研究对象,按照就诊顺序均分为研究组(对照组基础上采用改良早期预警评...目的探讨改良早期预警评分(modified early warning score,MEWS)在早期识别潜在危重症患者中的应用价值。方法选取我院急诊科2017年1月-2019年1月收治的200例患者为研究对象,按照就诊顺序均分为研究组(对照组基础上采用改良早期预警评分系统)和对照组(采用常规急诊分诊流程),然后根据评分结果分流至红、黄、绿区域,比较分两组患者分诊情况、去向以及转归情况。结果研究组绿区分组占比高于对照组(P<0.05);MEWS分数越高,患者病情越重,病死率越高。结论MEWS评分系统将急诊患者病情分值化,为护理提供有效的参考数据,可准确鉴别潜在危重患者,值得临床应用。展开更多
基金supported by the Health and Medical Research Fund of the Food and Health Bureau of the Hong Kong Special Administrative Region(Project No.19201161)Seed Fund from the University of Hong Kong.
文摘BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.
基金Capital Clinical Characteristic Application Research of Beijing Municipal Science & Technology Commission (Z171100001017057).
文摘BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate level.METHODS:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were enrolled.Demographic characteristics were collected.The primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation use.Outcome prediction value of parameters above was compared using receiver operating characteristics(ROC)curves.Cox regression analyses were carried out to determine the risk factors for the 28-day mortality.Kaplan-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and NEWS.RESULTS:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical ventilation.Among single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU admission.CONCLUSIONS:NEWS could be a valuable predictor in septic patients with CAP in emergency departments.Admission lactate did not predict well the outcomes or improve the severity scores.A qSOFA≥2 and a NEWS≥9 were strongly associated with the 28-day mortality,ICU admission,and mechanical ventilation of septic patients with CAP in the emergency departments.
文摘Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely face.Diagnostic options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limiting the use of invasive hemodynamic monitoring or imaging tests.The mortality rate due to sepsis can be assessed via multiple scoring systems,for example,mortality in emergency department sepsis(MEDS)score and sepsis patient evaluation in the emergency department(SPEED)score,both of which quantify the variation of mortality rates according to clinical findings,laboratory data,or therapeutic interventions.This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.Methods:The study is a cross-sectional,prospective study including 61 sepsis patients in ED in Suez Canal University Hospital,Egypt,from August 2017 to June 2018.Patients were selected by two steps:(1)suspected septic patients presenting with at least one of the following abnormal clinical findings:(a)body temperature higher than 38℃ or lower than 36℃,(b)heart rate higher than 90 beats/min,(c)hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg,and(d)white blood cell count higher than 12,000/μL or lower than 4000/μL;(2)confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment(SOFA)score following infection.Other inclusion criteria included adult patients with an age≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection.Patients were shortly follow-up for the 28-day mortality.Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome.The receiver operating characteristic curves were also done for MEDS and SPEED scores.Results:Among the 61 patients,41 died with the mortality rate of 67.2%.The mortality rate increased with a higher SPEED and MEDS scores.Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors(p=0.004 and p<0.001,respectively),indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients.Thereafter,the receiver operating characteristic curves were plotted,which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87(0.788-0.963)as compared with 0.75(0.634-0.876)for MEDS.Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system.For every one unit increase in SPEED score,the odds of 28-day mortality increased by 37%.Conclusion:SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients.Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.
文摘目的探讨改良早期预警评分(modified early warning score,MEWS)在早期识别潜在危重症患者中的应用价值。方法选取我院急诊科2017年1月-2019年1月收治的200例患者为研究对象,按照就诊顺序均分为研究组(对照组基础上采用改良早期预警评分系统)和对照组(采用常规急诊分诊流程),然后根据评分结果分流至红、黄、绿区域,比较分两组患者分诊情况、去向以及转归情况。结果研究组绿区分组占比高于对照组(P<0.05);MEWS分数越高,患者病情越重,病死率越高。结论MEWS评分系统将急诊患者病情分值化,为护理提供有效的参考数据,可准确鉴别潜在危重患者,值得临床应用。
